By Pension and Benefits Editorial Staff
In May 2018, the Trump Administration released a blueprint for lowering U.S. prescription drug prices, entitled “American Patients First.” The plan included proposals to create incentives for decreasing prices and reducing consumer out-of-pocket costs. It also included a request for information (RFI) from stakeholders. The ERISA Industry Committee (ERIC) has submitted comments in response to this RFI. ERIC’s comments focused on four areas: improving competition; better negotiation to reduce costs; creating incentives to lower drug prices; and reducing patient out-of-pocket spending.
“Large employers typically pay at least 75 percent of health care costs for their employees. While prescription drugs are not the largest cost-driver within employer-sponsored health insurance, they are the fastest growing, least predictable, and often times, the most opaque,” said James Gelfand, senior vice president of health policy at ERIC. “It is extremely important regulations are updated to increase competition and improve access to lower cost drug options.”
Fixes suggested by ERIC, included:
- Ensuring safety protocols are properly enforced and cannot be used to generate market exclusivity;
- Taking immediate steps to except value-based payments from the Medicaid price calculation and removing other barriers related to Stark and anti-kickback rules which might hamper the advance of value-based payments in health care;
- Banning pay-for-delay agreements and curtailing those currently in effect;
- Implementing changes to create a thriving biosimilar market, and educating patients and providers about it;
- Placing limitations on copay coupons that steer patients to higher-cost drugs;
- Broadening the IRS’ definition of preventive care; and
- Banning gag clauses that hide drug costs from consumers.
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